Figure 1
Step-by-step development of a conceptual model combining the Rainbow Model of Integrated Care [21] (1A), Realist Evaluation theory [2223] (1B), Coleman’s boat [2627] (1C) and ripple effects [28] (1D). The abbreviations used are S, strategy; C, context; M, mechanism; O, outcome; IACOP, integrated acute care for older people. The solid black arrows (#AB, #AE, #EB) represent situational mechanisms; the blue arrows represent individual (#BC) and organisational (#EF) action formation mechanisms; the green arrows (#CD, #CF, #FD) represent transformational mechanisms; the purple arrows represent ripple effects (#CB & #FE & #CE & #FB) and the black dotted arrow (#AD) represents a simplified view of a pure macro relationship. The nodes depicted are A, the macro context (system context); B, micro context (individual context); C, micro-outcome (individual actions); D, macro-outcome (transformation towards IACOP close to home); E, meso context (organisational context); and F, meso outcome (organisational actions).
Table 1
Definitions of main concepts of the SCMO configurations.
| Strategy (S) | Refers to intended plans of action [23]. In this study, strategies are aimed at transforming towards IACOP close to home. |
| Context (C) | Conditions that trigger or modify the mechanism [23]. In this study the contextual factors are functional or normative and apply to the individual (micro), organisational (meso) or system level (macro). |
| Mechanism (M) | Refers to the generative force that leads to transformation [23]. Mechanisms are no plans of actions, but responses to the strategies applied in differed contexts: they explain why strategies work or not. |
| Outcome (O) | Refers to intended or unintended process outcomes [23]. In this study we defined outcomes as individual and/or organisational actions that either positively or negatively impact transformation towards IACOP close to home. |
Table 2
Regional partnerships for IACOP close to home.
| DEGREE OF URBANISATION [32] | PARTNERS FOR IACOP CLOSE TO HOME | |
|---|---|---|
| R1 | Hardly urbanised | 1 general hospital, 1 nursing (home) organisation, 1 GP care group, 1 health insurer |
| R2 | Moderately urbanised | 1 general hospital, 1 nursing (home) organisation, 1 health insurer |
| R3 | Hardly urbanised | 1 topclinical hospital, 1 nursing (home) organisation, 1 health insurer |
| R4 | Moderately urbanised | 1 topclinical hospital, 1 nursing (home) organisation, 1 GP care group, 2 health insurers |
| R5 | Strongly urbanised | 1 general hospital, 1 nursing (home) organisation, 1 GP care group, 2 health insurers |
| R6 | Moderately urbanised | 1 general hospital, 3 nursing (home) organisations, 3 GP care groups, 1 mental health organisation, 1 health insurer |
| R7 | Moderately urbanised | 1 topclinical hospital, 3 nursing (home) organisations, 1 GP care group, 1 health insurer |
| R8 | Strongly urbanised | 1 general hospital, 1 nursing (home) organisation, 1 GP care group, 1 health insurer |
| R9 | Extremely urbanised | 1 university hospital, 1 nursing (home) organisation, 1 GP care group, 1 health insurer |
Table 3
Data collection and study participants.
| TYPE OF DATA | DESCRIPTION | PARTICIPANTS | OCCUPATION | ACTIVE IN REGION (R) |
|---|---|---|---|---|
| Documents | Minutes of 7 director meetings | 19 | Directors | 1×R1, 3×R2, 2×R3, 3×R4, 4×R5, 2×R6, 1×R7, 2×R8, 1×R9 |
| Documents | Minutes of 12 project leader meetings | 22 | Project managers | 3×R1, 2×R2, 1×R3, 1×R4, 5×R5, 2×R6, 2×R7, 4×R8, 2×R9 |
| Interviews | Transcripts of 10 semi-structured interviews | 11 | Project managers | 2×R1, 2×R2, 1×R3, 1×R4, 2×R5, 1×R6, 1×R7, 1×R8 |
| Focus groups | Transcripts of 2 focus groups | 8 | 5 project managers 3 experts | 1×R1, 1×R2, 1×R4, 1×R5, 1×R7 – |
Figure 2
Findings summarised into the conceptual model. The abbreviations used are S, strategy; C, context; M, mechanism; O, outcome; IACOP, integrated acute care for older people. The solid black arrows (#AB, #AE, #EB) represent situational mechanisms; the blue arrows represent individual (#BC) and organisational (#EF) action formation mechanisms; the green arrows (#CD, #CF, #FD) represent transformational mechanisms; the purple arrows represent ripple effects (#CB & #FE & #CE & #FB) and the black dotted arrow (#AD) represents a simplified view of a pure macro relationship. The nodes depicted are A, the macro context (system context); B, micro context (individual context); C, micro-outcome (individual actions); D, macro-outcome (transformation towards IACOP close to home); E, meso context (organisational context); and F, meso outcome (organisational actions).